Abstract: :
Purpose: The numbers of glaucoma-related surgeries in Medicarepatients reportedly have declined during the past several years.This study measured annual rates of trabeculectomy (TRAB) andargon laser trabeculoplasty (ALT) in a broader managed carepopulation to determine if the decline in surgery is limitedto Medicare patients.Methods: This retrospective, cohort studyused Protocare Sciences Proprietary Longitudinal Database thatincludes approximately 3 million insured members in commercialHMOs and PPOs as well as Medicare-risk plans. The primary outcomeswere rates of TRAB and ALT performed over 5 years (1996 to 2001)based on paid medical claims for patients 45 years and olderwho were receiving glaucoma pharmacotherapy (n=90,542). Thetime period at risk for surgery was estimated from the dateof the earliest observed prescription fill for a topical ocularhypotensive drug until either 1) end of continuous enrollment,2) end of the study period (12/31/2001), or 3) date of the firstTRAB or ALT. Poisson regression was used to evaluate how rateschanged over time after adjusting for age and sex.Results:Surgery rates declined between 1996 and 2001 at an estimatedadjusted annual rate of 18% for TRAB and 17% for ALT. TRAB ratesin patients <65 and >64 were 11.5 versus 11.4, respectively,per 1,000 patient years in 1996 and were 6.0 versus 3.5, respectively,per 1,000 patient years in 2001. Across all ages, the adjustedrate for TRAB in 2001 was 34% of the rate found in 1996 (95%CI, 27% to 42%). For ALT, the age-specific decline was similarbut more gradual. Across all ages, the overall 2001 ALT adjustedrate was 43% of the 1996 rate (95% CI, 37% to 51%).Conclusions:These results from a mixed-model managed care plan confirm previouslyreported findings for Medicare patients and demonstrate thatglaucoma-related surgery has declined rapidly among youngerpatients (45 to 64 years) as well. These declines may be attributablein part to recent advances in glaucoma pharmacotherapy.